title: Comprehensive vertebral deformity and vertebral fracture assessment in clinical practice: intra- and inter-reader agreement of a clinical workflow tool.
abstract: METHODS
  Study design randomized intra- and inter-reader reproducibility study.
  
  
  OBJECTIVE
  To evaluate reproducibility of quantitative morphometry (QM) and agreement of dichotomous fracture/no-fracture status on lateral spinal radiographs acquired during routine clinical practice using a clinical workflow tool.
  
  
  BACKGROUND
  Several recent guidelines have underlined the importance of Genant semi-quantitative scoring and selective QM to confirm and grade suspected vertebral fractures in clinical practice.
  
  
  METHODS
  Thoracic and lumbar spine radiographs were acquired from 98 consecutive subjects (mean age, 60.1 ± 11.7 yr) attending the clinic for osteoporosis evaluation. For each subject, QM and Genant semi-quantitative scoring were performed on all evaluable vertebrae from L4 to T4 using a software workflow tool. A radiologist and an experienced radiographical technician performed 2 repeat reading sessions of the radiographs 12 months apart, blinded to each other's results; for the second read, the cases were anonymized and the order was randomized.
  
  
  RESULTS
  Inter-reader reproducibility results were 3.1% and 3.2% coefficient of variation (%) for heights, 0.030 and 0.031 root mean square standard deviation for height ratios. For intrareader reproducibility, these values were 2.2% and 3.5% coefficient of variation %; 0.023 and 0.034 root mean square standard deviation. Kappa score results for agreement of dichotomous fracture/no-fracture status were 0.67 and 0.72 (inter-rater) and 0.50 and 0.67 (intrarater).
  
  
  CONCLUSIONS
  The software assessed in this study is a reliable clinical tool that facilitates QM and Genant semi-quantitative scoring of the spine in routine clinical practice.
  
  
  METHODS
  3.
authors.affiliation: *Department of Radiology, University of Foggia, Viale Luigi Pinto, Foggia, Italy †Department of Radiology, Scientific Institute Hospital "Casa Sollievo della Sofferenza," Viale Cappuccini, San Giovanni Rotondo, Foggia, Italy ‡Optasia Medical Ltd, Mellor House, Cheadle Hulme, Cheadle, United Kingdom; and §Optasia Medical Inc, Sudbury, MA.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Guglielmi
authors.forename: Jane
authors.initials: J
authors.lastname: Haslam
authors.forename: Francesco
authors.initials: F
authors.lastname: DʼErrico
authors.forename: Peter
authors.initials: P
authors.lastname: Steiger
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Nasuto
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods* / Q000592:standards; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010024:Osteoporosis / Q000175:diagnosis / Q000000981:diagnostic imaging*; D011859:Radiography / Q000379:methods* / Q000592:standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000175:diagnosis / Q000000981:diagnostic imaging*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging*